Fluids, electrolytes, & acid-base 3

Question 1

Sodium osmolarity of 350-375 mEq/L can cause

Answer 1

headache
agitation
confusion

Question 2

Sodium osmolarity of 376-400 mEq/L can cause

Answer 2

weakness
tremors
ataxia

Question 3

Sodium osmolarity of 401-430 mEq/L can cause

Answer 3

hyperreflexia
muscle twitching

Question 4

Sodium osmolarity of >430 mEq/L can cause

Answer 4

seizures
coma
death

Question 5

Which statements represent the BEST understanding of the physiologic role of calcium? (Select 2).
a. Calcium is factor 6 in the coagulation cascade
b. albumin administration can cause hypocalcemia
c. it is responsible for phase 1 of the cardiac myocyte action potential
d. acidosis increases ionized calcium

Answer 5

b. albumin administration can cause hypocalcemia
d. acidosis increases ionized calcium

Question 6

Normal plasma calcium is

Answer 6

8.5-10.5 mg/dL or 4.5-5.5 mEq/L

Question 7

Normal ionized calcium is

Answer 7

4.65-5.28 mg/dL or 2.2-2.6 mEq/L

Question 8

Parathyroid hormone ___________ serum calcium and calcitonin ___________- serum calcium

Answer 8

raises; lowers

Question 9

Calcium plays a crucial role in ________ of the cardiac muscle cell action potential

Answer 9

phase 2

Question 10

Important functions of calcium include

Answer 10

second messenger systems, neurotransmitter release, and muscular contraction (skeletal, cardiac vascular, bronchial, etc.)

Question 11

The primary treatment for hypercalcemia includes

Answer 11

IV hydration (0.9% NaCl) & a loop diuretic (furosemide)

Question 12

Calcium antagonizes the effects of _________ at the neuromuscular junction

Answer 12

magnesium

Question 13

Calcium is factor ___ in the coagulation pathway.

Answer 13

4

Question 14

Acidosis _________ionized calcium

Answer 14

increases

Question 15

Alkalosis ___________- ionized calcium

Answer 15

decreases

Question 16

What is the Chvostek sign?

Answer 16

tapping on the angle of the jaw–> facial contraction on the ipsilateral side

Question 17

What is the Trousseau sign?

Answer 17

an upper extremity BP cuff is inflated above SBP for three minutes, decreased blood flow accentuates neuromuscular irritability–> muscle spasms of the hand and forearm

Question 18

Etiology of hypocalcemia includes

Answer 18

hypoparathyroidism
vitamin D deficiency
pancreatitis
sepsis
renal osteodystrophy

Question 19

Presentation of hypocalcemia includes

Answer 19

skeletal muscle cramps
nerve irritability
laryngospasm
mental status changes–> seizures
Chvostek sign
Trosseau sign

Question 20

What are the EKG findings of hypocalcemia

Answer 20

long QT interval

Question 21

What are the reasons for hypercalcemia?

Answer 21

hyperparathyroidism
cancer
thyrotoxicosis
thiazide diuretics
immobilization

Question 22

What is the presentation of hypercalcemia?

Answer 22

nausea
abdominal pain
hypertension
psychosis
mental status changes–> seizures

Question 23

What is the EKG findings of hypercalcemia?

Answer 23

short QT interval

Question 24

Loss of deep tendon reflexes is MOST likely a consequence of:
a. hypomagnesemia
b. hypermagnesemia
c. hypocalcemia
d. hypercalcemis

Answer 24

b. hypermagnesemia

Question 25

Normal plasma magnesium (total) is

Answer 25

1.7-2.4 mg/dL or 1.5-3 mEq/L

Question 26

Magnesium antagonizes the effects of

Answer 26

calcium

Question 27

Clinical uses of magnesium include

Answer 27

pre-eclampsia opioid-sparing technique acute bronchospasm cardiac rhythm disturbances (symptomatic PVCs or torsades de points)

Question 28

Magnesium is required for normal ___________ function

Answer 28

cardiac

Question 29

What is the loading dose and dose of magnesium for pre-clampsia?

Answer 29

4 g load over 10-15 minutes then 1 g/hr for 24 hours

Question 30

Administration of magnesium for >48 hours increases the risk of

Answer 30

neonatal respiratory depression, hypotension, and lethargy

Question 31

Reasons for hypomagnesemia include

Answer 31

poor intake alcohol abuse diuretics critical illness common with hypokalemia

Question 32

Reasons for hypermagenesemia include

Answer 32

excessive administration renal failure adrenal insufficiency

Question 33

EKG findings of hypermagnesemia include

Answer 33

heart block

Question 34

EKG findings of hypomagnesemia include

Answer 34

long QT

Question 35

At a magnesium level of <1.2 mg/dL, you will see

Answer 35

tetany seizures dysrhythmias

Question 36

At a magnesium level of 1.2-1.8 mg/dL, you will see

Answer 36

neuromuscular irritability hypokalemia hypocalcemia

Question 37

At a magnesium level of 2.5-5 mg/dL, you will see

Answer 37

typically no symptoms

Question 38

At a magnesium level of 5-7 mg/dL, you will see

Answer 38

lethargy, drowsiness, flushing, N/V, diminished deep tendon reflexes

Question 39

At a magnesium level of 7-12 mg/dL, you will see

Answer 39

loss of deep tendon reflexes, hypotension, EKG changes, somnolence

Question 40

At a magnesium level of >12 mg/dL, you will see

Answer 40

respiratory depression--> apnea, complete heart block, cardiac arrest, coma, & paralysis

Question 41

How does magnesium work as an opioid-sparing drug?

Answer 41

it antagonizes NMDA receptors

Question 42

What classic sign should you assess in an OB patient receiving magnesium for preeclampsia?

Answer 42

loss of deep tendon reflexes